NC0074268_Effluent Pollutanct Scan Waiver Form_20160426

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April 26, 2016
RECEIVED/NCDEQ/DWR
Division of Water Resources MAY 0 2 2015
Surface Water Protection Section
1617 Mail Service Center Water Quality
Permitting Section
Raleigh, NC 27699-1617
Dear Sir or Madam:
Please find enclosed original 2016 NPDES Effluent Pollutant Scan Waiver Forms for each of the City of Gastonia Two
Rivers Utilities'three wastewater treatment facilities:
• Crowders Creek Wastewater Treatment Plant-NPDES#NC0074268 ,
• Long Creek Wastewater Treatment Plant-NPDES#NC0020184
• Eagle Road Wastewater Treatment Plant-NPDES#NC0006033
The next permit renewal applications for these facilities will not be due until 2020, so priority pollutants
scans can be conducted in 2017, 2018 and 2019 to meet the three year requirement.
If I may answer any questions or be of assistance, please contact me at 704-842-5106 or [e-mail].
Sincerely,
CDI C---/VL' y-----
David Shellenbarger
Assistant Division Manager-Compliance
Wastewater Treatment
Two Rivers Utilities
Certified Mail: 7014 0150 0002 0276 0791

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NCDWQ NPDES EFFLUENT POLLUTANT SCAN WAIVER FORM
In lieu of performing the required annual Effluent Pollutant Scan and to satisfy the NPDES reporting
requirement, a municipal wastewater treatment facility may complete and submit this form to NCDWQ if
the following criteria are met:
D The facility can still meet the requirement to perform three pollutant scans for its next NPDES
permit application; and
D Has a design flow greater than or equal to 1.0 MGD; or
D Is required to have a pretreatment program (or has one in place); or
D Is otherwise required by the NCDWQ to conduct an annual effluent pollutant scan.
Facility Name: Crowders Creek WWTP
NPDES Permit Number: NC0074268 Outfall Number: 001
Effective Date: 5/1/2011 (Complete form for each outfall discharging effluent to waters of
the state and requiring an annual Effluent Pollutant Scan.)
Expiration Date: 8/31/2015
Owner Information Person Certifying the Form
Owner ""Permittee Name Ci of Gastonia Certifier's Name: Ste hanie:Scl erin er ;
5tephanieScFieringer "' `"'
„; �: t�;-. e .
Title(if applicable): Division Manager Wastewater Title or Position with facility: Division Manager
Treatment Wastewater Treatment
Email Address: ste' haW,ofgastonia.com, Email Address: stephaniesCa ofgastonia.com
Mailing Address: PO Box 1748 Mailing Address: PO Box 1748
'City;State"ZiklOgtoiiiaffiNC 2805b3, g; a° ;Ci y;Stafe.Zip:"Gastonia,WC:2603'74,
Telephone: [phone] Telephone: [phone]
By completing and submitting this form, I, Stephanie Scheringer , (printed name) certify
that the effluent waste stream for the facility and outtall indicated above has not significantly changed
within the past year in a manner that would cause any of the listed parameters to be present or present in
concentrations greater than previously reported and I hereby submit this completed form to satisfy the
NPDES annual Effluent Pollutant Scan reporting requirement for calendar year 2016
I also attest that the facility can still meet the requirement to perform three pollutant scans for the next
NPDES permit application.
Certified by (signature): •
Position or title of certifier: Division Manager Wastewater Treatment
Date certified: c2.9-110
This completed form shall be submitted along with the Discharge Monitoring Report to the following address: Division
of Water Quality/Surface Water Protection Section/Central Files,1617 Mail Service Center,Raleigh,North Carolina
27699-1617.